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USMLE STEP3 Exam
Step3 (Page 24 )

Updated On: 12-Feb-2026
Page 24 of 162
PDF with 804 Questions

A 58-year-old male presents to your office for a well-male examination. It has been several years since he last visited a doctor, but he states that he has been in "excellent health." He denies any history of drinking, smoking, or using illegal drugs. He maintains a diet low in sodium and fat. An avid sports enthusiast, he also spends at least 2 hours per day engaged in some type of outdoor physical activity. On physical examination, you discover a translucent waxy papule with raised borders on the posterior aspect of his left shoulder.
The treatment modality associated with the lowest recurrence rate is which of these?

  1. radiation therapy
  2. Mohs micrographic surgery
  3. surgical excision
  4. electrodesiccation with curettage
  5. cryotherapy

Answer(s): B

Explanation:

Nonmelanoma skin cancer is the most common cancer in the United States. Of this group of cancers, approximately 7080% are basal cell carcinomas (BCC). The majority of the remaining 2030% are squamous cell carcinomas (SCC). Metastasis is less common in BCC than SCC, with an estimated risk for metastasis of less than 0.1%. There is no evidence that total body skin examination reduces morbidity or mortality associated with BCC. The cure rate of BCC ranges anywhere from 80 to 99% depending on the treatment modality employed. Despite adequate treatment, individuals with a prior BCC lesion are at increased risk for development of a subsequent BCC (with a 40% risk of development 35 years after treatment).

The most important risk factor for development of BCC is exposure to UVB (or shortwavelength ultraviolet) radiation. There is some evidence, however, that UVA (or longwavelength ultraviolet) radiation also confers a risk. Sporadic, intense episodes of sun exposure, particularly during childhood, are associated with increased risk of BCC development later in life. Conversely, SCC is apparently associated with cumulative sun exposure, regardless of intensity. Other risk factors implicated in BCC development include arsenic exposure, immunosuppression, exposure to other forms of radiation, and the presence of other skin- affecting conditions such as xeroderma pigmentosum and basal cell nevus syndrome.



An 18-year-old female presents for evaluation of facial acne. On examination, she has multiple comedones, papules, and pustules on her forehead, nose, cheeks, and chin. She also has several distinct nodules, each greater than 5 mm in diameter. Which of the following is most appropriate for initial inclusion in a regimen to treat this patient's acne?

  1. erythromycin gel
  2. tretinoin 0.025% cream
  3. clindamycin lotion
  4. oral tetracycline
  5. oral isotretinoin

Answer(s): D

Explanation:

This patient has nodulocystic acne which is characterized by the presence of multiple comedones, inflammatory papules, pustules, and large nodules. Characteristically, the nodules measure greater than 5 mm in diameter. Initial therapy should include a systemic antibiotic such as tetracycline or erythromycin. Use of local therapy alone may be adequate in individuals with comedonal acne. In cases of acne which feature more of an inflammatory component (with papules and pustules), topical and oral antibiotics are useful. Oral isotretinoin is indicated for severe nodulocystic acne that is unresponsive to other therapies.



An 18-year-old female presents for evaluation of facial acne. On examination, she has multiple comedones, papules, and pustules on her forehead, nose, cheeks, and chin. She also has several distinct nodules, each greater than 5 mm in diameter.
After 6 months of appropriate treatment, the severity of your patient's acne remains essentially unchanged. You rule out several potential causes for the patient's recalcitrant acne and decide that more aggressive therapy is warranted. As you discuss this option with your patient, which of the following side effects of the proposed treatment necessitates extensive counseling prior to initiation of therapy?

  1. pseudotumor cerebri
  2. teratogenicity
  3. hepatotoxicity
  4. nephrotoxicity
  5. cardiotoxicity

Answer(s): B

Explanation:

This patient has nodulocystic acne which is characterized by the presence of multiple comedones, inflammatory papules, pustules, and large nodules. Characteristically, the nodules measure greater than 5 mm in diameter. Initial therapy should include a systemic antibiotic such as tetracycline or erythromycin. Use of local therapy alone may be adequate in individuals with comedonal acne. In cases of acne which feature more of an inflammatory component (with papules and pustules), topical and oral antibiotics are useful. Oral isotretinoin is indicated for severe nodulocystic acne that is unresponsive to other therapies.



A23-year-old presents with the history of a suspected spider bite to the left groin. On questioning, no one saw a spider. The patient has been healthy except occasional boils under his arms and in the groin.
The patient is afebrile. No family members are sick.



Appropriate treatment would include which of the following?

  1. Benadryl and topical steroids
  2. surgical debridement
  3. incision and drainage
  4. treatment with TMP-SMZ
  5. observation and instructions to the patient to pop any pustules to help it drain

Answer(s): D

Explanation:

Above shows a pustule or furuncle with a necrotic center. With the patient having a history of boils under his arms and groin, a S. aureus infection should be suspected. Communityacquired methicillin- resistant S. aureus (MRSA) infection has been described to present as an appearance similar to a spider bite. Brown recluse spider bites have necrotic centers, but do not usually form pustules. TMP-SMZ is the best oral agent available for MRSA. Benadryl and topical steroids would not be indicated. Surgical debridement is not indicated. If there is a large pustule, incision and drainage of the wound may be useful. Alternatively, a needle aspirant of drainage could be sent for culture. Patients should be instructed not to press on these lesions to express puss. This causes bacterimia and can later lead to serious systemic infections due to S. aureus. If a patient with S. aureus infection becomes febrile, he should be admitted to the hospital for systemic antibiotics. Blood cultures should be taken. S. aureus easily forms abscesses in the skin and in other tissues. Blood-borne infection causes endocarditis, renal furuncles, and osteomyelitis.



A23-year-old presents with the history of a suspected spider bite to the left groin. On questioning, no one saw a spider. The patient has been healthy except occasional boils under his arms and in the groin.
The patient is afebrile. No family members are sick.



The patient is sent home and a day later develops chills, fever, and the lesion is spreading. Appropriate treatment would include which of the following?

  1. hospital admission, blood cultures, and vancomycin
  2. systemic corticosteroids
  3. surgical excision of any necrotic tissue
  4. observation and monitoring at home with oral clindamycin
  5. hospital admission, blood cultures, and ceftriaxone

Answer(s): A

Explanation:

Above shows a pustule or furuncle with a necrotic center. With the patient having a history of boils under his arms and groin, a S. aureus infection should be suspected. Communityacquired methicillin- resistant S. aureus (MRSA) infection has been described to present as an appearance similar to a spider bite. Brown recluse spider bites have necrotic centers, but do not usually form pustules. TMP-SMZ is the best oral agent available for MRSA. Benadryl and topical steroids would not be indicated. Surgical debridement is not indicated. If there is a large pustule, incision and drainage of the wound may be useful. Alternatively, a needle aspirant of drainage could be sent for culture. Patients should be instructed not to press on these lesions to express puss. This causes bacterimia and can later lead to serious systemic infections due to S. aureus. If a patient with S. aureus infection becomes febrile, he should be admitted to the hospital for systemic antibiotics. Blood cultures should be taken. S. aureus easily forms abscesses in the skin and in other tissues. Blood-borne infection causes endocarditis, renal furuncles, and osteomyelitis






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